Ruptured Patellar Tendon Surgery

[Bmcnamara417]

Hi folks - although I have been a regular reader of this forum during my recovery process, I have yet to post.  I am a 43 y/old firefighter, (previously) very physically active and fit.  I am ten weeks out from patella tendon repair of my left knee.  Recovery has been unremarkable, but my mental game is starting to lag.   I am at 125degrees ROM, and have just began light body weight exercises.  I am wanting to do much more than i can - and am cautious about any re-rupture risk.  I can sorta walk around, but with a terrible limp.  Still in my brace at all times minus sleeping - brace opened to 40degrees. 

I am wondering if there is a 'breakthrough' wherein I will feel like myself (or some version) again.  I am hoping to get back to my normal job as a firefighter at the 6 month mark...  Any experiences or pep-talks appreciated.  Thanks.

I did the same in 2012 and was back on the rig in 3 months...just blew my the knee last week....let's see how fast I can make it back this time at age 41.

[diane72]

Hello Bmcnamara,

Welome back! My rupture of my right patellar tendon was related to my 4 year old too (I never noticed her scooter under my feet while trying to rush her out the door to nursery). I'm 43 so similar ages to you. I'm not a firefighter but I do love adventures, so determined to get back to fitness (we had really hoped to get to Angel Falls when Iona was old enough and I know it involves a trek through the jungle, I really don't want to give up on that dream).

The first few days are the toughest so hang on in there. The different protocols across the world are interesting. I am not able to move my bad leg forward with the crutches so have to go sideways. But they have my brace at 0-30 degree bend I wonder if it was locked straight if I would find it easier. My NHS consultant said it was 'too soon' for physio (I'm 4 weeks post surgery, 6 weeks post accident) but he also gives no advice on 'how' to achieve things like using the crutches and bending my knee so I have booked myself in privately with a physio tomorrow to get advice on tenchinques o use to better use the crutches etc.

Wishing you lots of luck!!!!

Diane

[diane72]

I have breakthrough! First time ever I was able to lift my damaged leg off the ground. Only a tiny bit and only for a short time BUT it's a breakthrough for me after 6 weeks from injury, 4 weeks from op., as if I can do that it will be a route to getting off the wheelchair onto the crutches more.....

How's everyone else doing today?

 

Diane

[John42]

Hi Diane

Well done   

JohnK/ Manchester UK

[Bmcnamara417]

Diane,

It is my Dr's protocol to start PT ASAP.  In fact I am going this afternoon.  With your brace fully locked out you should be able to bare weight and even walk.  This approach is the same one I used in 2012 allowed me to recoup in three months.  I have another friend the did the same thing in 2011 and his doctor went with the less aggressive therapy.  His leg still isn't right.  I also have an cold water circulation machine and an electro stem device.  I lived on those things the last time....I know it speeded my recovery big time!

[diane72]

Thanks John!

Hi Bmcnamara, yes there definitely seems to be a transatlantic divide on how they handle these injuries and you guys do seem to be to have physio much earlier. I do think some of it is the NHS don't want to fund things and are totally under-resourced. I did tell them I'm happy to pay for it but I think part of it is they can't admit it would be useful as then they feel obliged to give it!

I do wonder if part of my issue is also fear and anticipation of pain. After being sent home with only crutches and no leg support originally and having the most excruciatingly painful next fortnight of my life prior to surgery I think my brain is subconsciously saying 'be careful'. I also know about day 10 after the fall (prior to surgery) my quads started going into spasm if I attempted to lift my leg to hop on the crutches whereas prior to that although very painful just from the vibration I could hop on the good leg.

My leg brace is set 0-30 flex at all times and I was told 'not to touch it'. The private physio I'm going to see tomorrow is based in a private hospital so has experience in this operation. I won't go beyond what the NHS consultant says tomorrow with the prvate physio (which was just get about on the crutches more and bend to 30) but I hope to get some practical advice and have an expert giving me the confidence on doing the crutches right and then a whole list of suggestions so that I can grill the NHS consultant on Thursday on moving forward. I will ask the physio about the electro stim device-the NHS won't provide one but the private hospital may hire them. Although the consultant gave me no exercise advice I have been doing some heel slides, quad clenches with my heel on a book and ankle pumps to keep the circulation going and I'm pretty sure I would not have achieved the 30 degrees ROM he asked me to get to had I not done that-thank goodness for the internet so we can all connect!

Really interested to hear what your physio recommends would be really good to compare notes! Good luck, I hope it goes well!

Diane

[Bmcnamara417]

Diane,

Jump online and google some the American treatment plans.  There are documents all over the place that layout the aggressive treatment.  Drill your private therapist with the info.  This is the knee brace I have:

http://www.djoglobal.com/products/donjoy/x-act-rom-knee.  Its awesome. 

Here is a link to a very similar rehab that I will be doing.

https://www.google.com/url?sa=t&source=web&rct=j&url=http://www.uwhealth.org/files/uwhealth/docs/pdf6/SM_pat_tendon_quad.pdf&ved=0ahUKEwjKnougjYzLAhUHuYMKHbhcBjIQFggbMAA&usg=AFQjCNH7LdncPXxdpE1_hyBTHFVmAZxn6g&sig2=2DZm7P5Crro-AErPu-EJdA.

I also have an ice water circulating machine...it is a life saver...see link
http://www.amazon.com/Polar-Products-Inc-Active-Therapy/dp/B001ALNM3A/ref=sr_1_2?ie=UTF8&qid=1456183801&sr=8-2&keywords=ice+water+circulator

Check it out!

PT UPDATE!

You are gonna hate me...just got back from my 1st PT appt. It was with the same guy I worked with 4 years ago.  We got the knee to 50 degrees range of motion. I can bare weight as tolorated as long as the brace is locked.  I can send you the exercise sheet he gave me with some really good simple stuff you may or may not already be familiar with. We actually talked about your case a little bit...

[diane72]

Hi Brett,

50 degrees-that is amazing for a first session!!  sounds like you made a great start! It's also great it is the same person you had before (but rubbish you have to meet again) as he will know what worked for you the last time, which I think will really help. Sounds really positive- onwards and upwards from now on!

Thanks for the links, I will have a look at the ice water circulating machine too-how often do you use it? Would love to see a copy of the exercise sheet ([email protected]).

Cool knee brace, I kind of feel like we should all be in the Matrix or something, ha ha ha. 

So tomorrow is a new day, which will hopefully bring great things!

McNamara is a very Scottish sounding name, I'm a Scot, my maiden name is MacArthur

Off to bed now as it's nearly 1am here, talk soon, night!

Diane

[diane72]

Hi everyone,

So I went to my first physio appointment today. Alot of it was her taking my history today but she did get to the bottom of my inability to lift my leg with crutches. She said sometimes after a very painful injury for a few weeks your brain subconsciously shuts off activation of your muscles that were causing the pain, so in addition to us having to address the weakness I need to consciously over-ride it. She showed me how to focus on that area of the quads just above the patella (I think my gluts kept taking over when I was trying to build my quads on my own before) and she got that muscle firing again-a bit twitchy just now but I have hourly exercise that should build it. Once that strengthens I should have an easier time getting back on the crutches. She also showed me how to do the heel slides properly (with the aid of my scarf on the foot for now) and also said to keep doing the hourly ankle pumps as I was doing. She didn't go any further today as she wanted me to talk to my consultant on Thursday about doing the heel lifts with a towel under the knee and also about going beyond toe weight bearing to get his permission (aswell as opening the degree of ROM up to 60). Certainly I feel much better for having seen her today and will see her again next Wednesday.The car was a million fold easier to get into today aswell so that was a huge relief (thanks for the tips John42).

Thanks Brett, for all the info you sent over it was really helpful and I will discuss more of it with the physio next week (never got to talking devices etc.). How is it going for you today?

Hope everyone else is doing OK too?

Diane 

[Bmcnamara417]

Well it sounds like she was very helpful!  That's great!  The key is to be as aggressive as possible with the exercises and getting that quad to fire is super important!  I myself am having a lazy day.  Wife at work, son at school, daughter at daycare!  It's almost 11am, so I need to get off my butt and get some exercises in.  Knee was pretty sore this moening....feels better now thanks to pain meds. 

[diane72]

Hi Brett,

Sorry to hear you had some pain today, you are still really early days and I know the first few weeks I had quite alot of pain beofre it started easing off. As for me I made it to the bathroom and back from the living room on the crutches today, which is definitely progress for me, getting out of the wheelchair dependancy gradually. Been doing my physio stuff and I swear it is already beginning to help get that muscle firing again.

Enjoy your peace & quiet! My 4 year old has just come running back in the door with Daddy from her daycare!

Diane 

[diane72]

Hello All,

So I saw my NHS consultant today, I was unlocked to work up to 60 degrees ROM and given the blessing to do the exercises with the private physio. I've to go back in a few weeks to the plaster room to have my brace unlocked to 90 degrees (not sure why I wouldn't just do it myself) but the consultant isn't seeing me again until 7th April. I'm 4.5 weeks post-surgery, seems a long time 7 weeks until I see my consultant next-what do you think? What is the experience of others at this stage?

Diane

[diane72]

Hello Everyone,

SO another breakthrough for me (thanks to Brett! thank you, thank you, thank you). As you know I was struggling to get out of the wheelchair onto the crutches so I tried the 'American approach' and locked my brace at 0 degrees rather than in the permanent flex mode (0-30 previously and now 0-60) that I had. Wow, so much better and I am now able to move forward on the crutches quite well in the house. So I'm going to do that for a few days, locking it at 0 to give me the support I need to start moving then opening up to the 0-60 for my ROM exercises and when sitting around/sleeping). I think the key is that my ROM is probably ahead of my muscle strength (probably partly as I had a fortnight before the op. even took place). In parallel, I'll be doing those exercises to improve muscle strength.



 

Diane

[Bmcnamara417]

See I told you!  I bet you will we bearing weight and walking around in no time as long as you stay locked at zero when you do it!  1 week 3 days post surgery and very rarely using crutches around the house at all.  And yes as your get more range of motion you should definitely unlock your brace when sitting, riding in car sleeping and relaxing.  Do those slides and leg raises.  You could add more than once a day....I would say at least 3 times a day or more on all of the exercises I set you.  And try to get you quad to flex when ever you think about it....you will be flying around the house in no time!

[diane72]

Hi Brett,

What you have managed in 1 week 3 days is great!!!! At what stage do you plan to attempt a step up/down (no idea when that happens). I've been thinking about that a bit as there is a small step into/out of my house and it is the one barrier I've been thinking about when I give the wheelchair back in a few weeks. How is everything else going?

As for me I've been using the crutches to go about the house mostly and only the wheelchair for when I need my hands free (like using my pincer stick to pick up the millions of 4 year old toys, pens and pads in the living room while holding her toy box!!). The exercises are going well (doing them all about 3-4 times/day but with added heel slides and quad clenching more often. I can feel the muscles are 'awake' now and they just need to get alot stronger.

Now that I am progressing on the cutches I've sent an e-mail to the secretary of my surgeon to see if I am permitted to move from toe-weight bearing to weight bearing as tolerated. His secretary sent me an e-mail today to say she would ask him, so just waiting on the reply.

Hope everyone has a good day,

Diane---